Cardiac Care

Background: Serum cardiac troponin (cTnI) and creatinine kinase-MB (CK-MB) levels are now widely used in the diagnosis of myocardial infarct (MI) and injury in living patients, but their utility in postmortem diagnosis has not been established.
Objective: Determination the specificity of the cTnI and CK-MB assay by using peripheral and pericardial blood samples compared with microscopic cardiac pathology for diagnosis of myocardial infarction in sudden deaths, and to find out whether it is practical and significant enough to estimate post-mortem interval by analyzing quantitatively the pericardial enzyme activity changes.
Materials and Methods: during the period from September 2013-July 2014 all cases of sudden death due to possible myocardial infarction (MI) that were received by Forensic institute at Rizgary teaching hospital in Erbil governorate, were investigated for possible underlying MI because of their sudden and unexpected death by histopathological examination and cardiac enzymes. In addition 17 cases of sudden death due to non-cardiac causes were involved as control group.
Results: The cases comprised 49 (92%) males and 4 (8%) females, with ages ranged from 18 to 92 years and the mean age of cases was 48.5 + 18.5 years. These cases divided into two main groups, those who died due to MI (36) cases and there were 24 cases had (acute MI) group A, 12 cases had (old MI) group B, and the other 17 cases who died due to other cause than MI group C control group. The highest level of cTnI in all three groups was in group A. While for CK-MB the highest level of was in group A. The sensitivity of cTnI is 94% (34/36) which is acceptable and the specificity for diagnosing of MI is 88% (15/17). While the sensitivity and specificity of CK-MB in which the result of the sensitivity is 86% (31/36) and the specificity of it is 82% (14/17). And also there was a strong positive II
correlation between CTnI and CK-MB, r = 0.662, n=36, p<0.0001. Postmortem interval correlate with cTnI level and CK-MB level by using Pearson correlations. (r) There was positive correlation between time interval and cTnI level(r= 0.164, n=36, p=0.340) and there was also correlation between time interval and CK-MB level (r= 0.301, n=36, p= 0.075)
Conclusion: evaluation of the biocardiac enzymes of cTnI and CK-MB represents a highly sensitive and specific marker of myocardial lesion in postmortem.

Objective: To investigate the effects of Acknowledge, Introduce, Duration, Explanation, and Thank you (AIDET) communication program on satisfaction among patients and families at cardiac care unit, Bangkok Heart Hospital.
Material and Method: This study was done using pre-post study design. A patients and families satisfaction report was collected by the Quality Information Management Department, Bangkok Hospital. Data were collected precommunication program implementation from January to December of 2014 and post AIDET communication program implementation from January-December of 2015 with a telephone structured interview guideline. Data were analyzed using descriptive statistics using percentage and comparing two proportions using Test of two proportion
Results: A total of 882 respondents were accepted to provide their information. After the communication program implementation, patients and families satisfaction raised from 46.1-54.8% to 56.4-62.2% and was higher than those before the program implementation
Conclusion: This communication program could be an effective intervention to increase patients and families satisfaction. Health care providers could employ this communication program to improve communication behavior in which to improve quality of care.

Doxorubicin (DOX) is a broad spectrum anthracycline antibiotic used
to treat multiple cancers. The use of DOX is limited by significant
cardiotoxicity,  hepatotoxicity  and  nephrotoxicity.  Quercetin  is  a
dietary-flavonoid found in plants which prevents oxidant injury and
protects against lipid peroxidation. The objective of the present study
was to assess the possible protective role of quercetin on doxorubicin
induced  hepatic,  cardiac  and  renal  toxicity  in  male  Wistar  rats.
Doxorubicin  (10mg/kg  body  weight)  was  administered  twice  and
quercetin  (100mg/kg  body  weight)  was  administered  on  all  the  21
days of the experimental period. Body weight, heart weight, creatine
kinase in serum and heart, the activities of the antioxidant enzymes in
liver,  heart  and  kidney  were  decreased  in doxorubicin  administered
rats. Liver and kidney weight, liver marker enzymes in serum, liver
and  kidney,  lactate  dehyrogenase  in  serum,  liver,  heart  and  kidney,
urea and creatinine in serum, lipid peroxide content in liver, heart and
kidney were increased. All the biochemical parameters mentioned
above  were  restored  to  near  normal  levels  on  quercetin
administration with doxorubicin. Administration of doxorubicin in
rats  altered  the  biochemical  parameters  but,  did  not  cause  much
effect on the tissues such as liver, heart and kidney which is evident
with histological studies.

In children, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections typically result in a less severe coronavirus 19 (COVID-19) presentation than in adults. However, a subset of children presents with severe multisystem inflammation associated with recent SARS-CoV-2 infection or COVID-19 exposure in the previous weeks. The Center for Disease Control (CDC) has termed this condition a multisystem inflammatory syndrome in children (MIS-C). MIS-C causes significant cardiovascular involvement, which can be a determinant of clinical course and outcomes. A subset of MIS-C patients presents with hypotension and shock either from acute myocardial dysfunction or systemic vasodilation, with at least of third of patients developing cardiac manifestations from the illness. In addition, myocarditis, pericarditis, valvular regurgitation, coronary artery involvement, and arrhythmias have been reported, with a smaller subset of patients requiring extracorporeal membrane oxygenation. Here, we report our institutional experience of MIS-C over the last year and present a narrative review of cases reported in the literature. In addition, we discuss the clinical protocol of diagnosis and acute and follow-up management of these patients with MIS-C.

Objectives: The study sought: 1) to survey the type of courses teaching adult life support and pre cardiac arrest management provided by UK hospitals and medical schools and required by professional bodies; 2) to describe both the curriculum content and applied teaching methods used the most popular in-hospital adult life support courses; and 3) to examine the fidelity of adult life support courses and their implementation in England; 4) to stimulate policy makers in other countries that are examining the utility and effectiveness of life support courses

Methodology: We surveyed the prevalence, distribution and impact of the resuscitation training population among UK health trusts. We conducted semi-structured telephone interviews with a randomised sample (n=30), and then a detailed thematic analysis of written and online course materials.

Results: We found a large number of both providers and types of life support courses for health care professions, the public and special groups such as divers. All but one of the thirty English NHS Hospitals surveyed provided adult life support courses. The Resuscitation Council UK Advanced Life Support (ALS) course was run by a majority (n=20) of the acute hospital trusts surveyed. Many hospitals ran ‘in-house’ courses alongside or in addition to the national (franchised) courses. Our survey revealed that courses aimed at the recognition and management of pre-arrest deterioration are now widely taught in hospitals (n=25). The survey of UK medical schools (n=25) revealed that while life support training was provided at all sites, courses varied and those aimed at the recognition and management of acutely ill patients were provided by only six sites. Only three professional colleges surveyed (n=16) required members to provide evidence of life support skill competence. Although many hospital sites have endeavoured to customize the three most widely provided courses to 2 produce ‘in-house’ courses, the franchised course format was followed with meticulous fidelity.

Conclusions: There are a small number of market leaders for the main franchised resuscitation courses. The teaching and provision of life support courses is now institutionalised in the hospital sector. Courses are implemented with great fidelity when compared by curriculum content. There has been a large increase in uptake of ‘pre-arrest’ courses. More study is needed to assess the impact of these courses on clinical care and patient outcomes.

The purpose of this investigation was to evaluate factors affecting the outcome following penetrating cardiac trauma in a developing country and to compare our results with others in developed countries. Analysis of the cause of trauma, age, sex, different tools of investigations used, concomitant organ injuries, SBP, GCS, ISS, RTS, TRISS and mortality were performed. This study included 35 patients; all were males. Mortality rate was 22.8%. It was significant with low SBP (p =0.021), GCS ˂ 9 (p =0.02), non-presentation with tamponade (p = 0.023), low ISS (p =0.02), low RTS (p =0.007), low TRISS (p = 0.003), less blood transfusion (p =0.001) and longer time before entrance to OR (p= 0.019). Meanwhile, mortality were not significant with age (p =0.33), mechanism of injury (p =0.16), other associated injuries (p =0.16) or associated intra-abdominal injuries (p= 0.16). Rapid assessment and prompt surgical intervention may reduce mortality. Even in a developing country, mortality rates could reach those in developed countries depending on clinical skills and accessible technology tools.

Abstract
Background: Myocardial infarction is a life threatening disease that influences  the physical, psychological and
social dimensions of  the  individual. Improper  lifestyle  is one of  the causes of  this disease.  The  designing and
implementing    of    nursing    intervention  protocol  for MI  patients  could    be    one    of    the    important    and
fundamental steps in improving MI patients outcomes. Aim: The aim of this study was to examine the impact of
a designed nursing intervention protocol on myocardial infarction patient’s outcomes as indicated by higher post
total mean knowledge  scores, higher post  total mean practices  scores and high  level of  compliance  to  lifelong
instruction. Research hypotheses: H1. Patients who will be exposed to a designed nursing intervention protocol
will have  a higher post  total mean knowledge  scores; H2. Patients who will be  exposed  to  a designed nursing
intervention protocol will have a higher post total mean practices scores; H3. Patients who will be exposed to a
designed nursing  intervention protocol will have a high  level of compliance  to  lifelong  instruction. Design: A
quasi-experimental  research design was utilized  in  this study Sample: A convenience sample of 40 adult male
and female MI patients. Setting: The cardiac care units at a selected Cairo University Hospital were recruited to
fulfill  the  aim of  this  study. Tools: Four  tools were  formulated&  tested  to  collect data pertinent  to  the  study;
Socio-demographic and medical data sheet, Pre/Post knowledge questionnaire sheet, an Observational checklist
and Compliance assessment sheet. Structured interview, reviewing medical records and direct observation were
utilized for data collection. Results: The study results revealed that the post total mean knowledge scores of the
studied  subjects  is  increased  significantly  with  value  of  t=  20.6  at  p=0.000,  higher  post  total  practice  scores
among  the  studied  subjects  with  t&  p  values  (t=5.6  at  p=  0.000  )  also,  studied  subjects  had  mild  to  high
compliance  level  regarding  the  lifelong  instructions.  Conclusion:  It  can  be  concluded  that,  enrichment  of
patients'  knowledge  and  practices  in  relation  to  their  condition  and  utilization  of  the  effective  nursing
intervention  protocol  as  an  approach  of  care  could  have  a  positive  impact  upon  improvement  of  patients'
outcome.  Recommendations:  The  study  recommended  Conduction  of  further  studies  in  order  to  assess  the
effectiveness of the designed protocol on patients' outcome regarding different cardiac disorders with replication
of this study on a larger probability sample from different geographical locations at the Arab Republic of Egypt,
in addition to establishment of cardiac rehabilitation center in the different heath care organizations.
Keywards: Nursing intervention protocol, Myocardial Infarction, Outcomes, Cardiac care units.

Alternate nostril breathing (ANB) is one of the best and easiest breathing exercises (pranayama) of yoga that are good for health and physical fitness. ANB exercise has beneficial and therapeutic effects on respiratory function in both normal as well as diseased humans. This study was conducted with the objective of assessing the physiological effects of short-term ANB exercise on respiratory function in healthy adult individuals leading a stressful life. This prospective interventional study was conducted in the Department of Physiology, Chittagong Medical College (CMC), Chattogram, Bangladesh from July 2017 to June 2018. A total of 100 participants aged 18-20 years, studying in the first year in CMC, were included by using a simple random sampling method. Among them, 50 participants were enrolled in the experimental group. Age-and BMI-matched 50 participants constituted the control group. Height, weight were measured, and BMI was calculated. The participants of the experimental group performed ANB exercise over 4 weeks for 10 min/day. The control participants were neither trained nor allowed to practice nostril breathing during the whole study period. Respiratory parameters like forced vital capacity (FVC), forced expiratory volume in 1st second (FEV 1), and peak expiratory flow rate (PEFR) were measured by using a digital spirometer (Chest graph HI-101, Japan). Readings were

Background— Using automated external defibrillators (AEDs) that implement the Guidelines 2000 resuscitation protocol constrains administration of cardiopulmonary resuscitation (CPR) to &lt;50% of AED connection time. We tested a different AED protocol aimed at increasing the CPR administered to patients with out-of-hospital cardiac arrest. Methods and Results— In a randomized controlled trial, patients with out-of-hospital cardiac arrest requiring defibrillation were treated with 1 of 2 AED protocols. In the control protocol, based on Guidelines 2000, sequences of up to 3 stacked countershocks were delivered, with rhythm analyses initially and after the first and second shocks. The study protocol featured 1 minute of CPR before the first shock, shorter CPR interruptions before and after each shock, and no stacked shocks. The primary end point was survival to hospital admission. Of 5107 out-of-hospital cardiac arrest patients connected to an AED, 1238 required defibrillation, and 845...

Background: To investigate the association between hyperuricemia and major adverse cardiac events (MACE) in patients with acute myocardial infarction (AMI).

Methods: Consecutive patients admitted with AMI to the Coronary Care Unit at R. K. Khan Hospital (Durban, South Africa) between the years 2006 and 2014 were included. Demographic data, including clinical and biochemical information stored in an electronic database, were obtained from all patients.

Results: A total of 2683 patients were studied, of whom 65% were males. The mean age of the participants was 57.1 ± 11.5 years, with 79% presenting with ST elevation myocardial infarction. Sixty-one percent were smokers, 59% had diabetes mellitus, 52% had hypertension, and 58% presented with a family history of premature coronary artery disease. Twenty-six percent (n = 690) had hyperuricemia, were older (59 ± 12.1 vs. 56.5 ± 11.2 years) and more likely to present with hypertension (P < 0.001), lower ejection fraction (P < 0.001), and higher median creatinine levels (P < 0.001). A significantly greater proportion of patients with hyperuricemia experienced MACE (45% vs. 30%, P < 0.001). In both sexes, considerable heterogeneity for risk factors and clinical events was noted in individuals with hyperuricemia. Multivariable analyses for risk factors associated with mortality suggest that hyperuricemia conferred a significantly increased risk of mortality after adjustment [odds ratio (OR) 1.7 (95% confidence interval 1.0–2.8); P = 0.042]. A significant increasing risk trend for MACE was observed for increasing tertiles of serum uric acid concentrations above normal (P < 0.001), particularly for cardiac failure (P < 0.001) and death (P = 0.006).

Conclusions: Hyperuricemia is significantly associated with hypertension, renal dysfunction, MACE, and independently confers a higher risk of mortality in patients with AMI. Significant heterogeneity was found by gender for risk factors and clinical events in individuals with hyperuricemia. A graded increase was demonstrated in the risk of MACE, particularly for cardiac failure and death, by increasing tertiles of hyperuricemia.

Introduction: Alternate nostril breathing (ANB) is an effective breathing exercise with therapeutic benefits on cardiorespiratory functions for healthy and diseased individuals. This study was conducted to assess the effects of ANB exercise on cardiorespiratory tasks in healthy adults. Materials and Methods: This randomized experimental study was conducted in the Department of Physiology, Chittagong Medical College, Chattogram, from July 2017 to June 2018. A total of 100 1st-year students, aged between 18 and 20 years, were included by a random sampling method. Fifty participants (25 males and 25 females) were enrolled in the experimental group, while age- and body mass index-matched another 50 participants (25 males and 25 females) served as the control group. Experimental group participants performed ANB exercise for 4 weeks. Cardiorespiratory parameters (pulse rate, blood pressure, forced vital capacity, forced expiratory volume in 1st s [FEV1], and peak expiratory flow rate [PEF...

Recently, there have been more reports of cardiac valve infections due to


the increasing number of intravenous (IV) drug abusers and chronic renal
failure patients. Among cardiac valves, tricuspid valve is most commonly
affected in the course of endocarditis.
Appropriate management of these patients is a challenging and
controversial issue in the field of cardiac surgery. Treatment options in
such cases include IV antibiotics, surgical excision alone, and surgical
excision with the re-implantation of prosthetic valve.
In this study, we present a case of tricuspid valve endocarditis (TVE),
confirmed by echocardiography, in a young IV drug abuser. Tricuspid valve
replacement was performed by using a biological prosthesis with
remarkable results in the early and long-term follow-up of the patient.

Background–Diabetes self-management is crucial component of diabetes treatment Aims–To examine to effectiveness of DSME among patients with diabetes type 2 in Indonesia Methods–A quasi-experimental design was applied as pilot study by inviting respondents using purposive sampling, divided into intervention (n=12) and control (n=12) group by matching age and education level. Data were collected at baseline and 1 month later using modified questionnaires and observation sheets. The intervention group received individual DSME program and book of diabetes for one-month (4 time home visit, 60 minutes) meanwhile usual care was carried out for control group. Results–Analysis of Mann Whitney U test showed there was significant difference on knowledge (p=0.000) and attitude (p=0.011) of diabetes self-management between intervention and control group. Furthermore, Wilcoxon signed rank test revealed significant increasing score of knowledge (I=0.002, C=0.015) and attitude (I=0.007, C=0.345). O...

Abstract Introduction: Retroperitoneal haemorrhage is a clinical entity that can present as a rare
life-threatening event, causing significant morbidity and representing a diagnostic challenge.
Case presentation: We report the case of a patient with double mitral and aortic valve replacement
on oral anticoagulant who presented with retroperitoneal haematoma after left oophorectomy for
ruptured huge ovarian cyst which was treated conservatively.
Conclusion: Delay in diagnosis is potentially fatal and high clinical suspicion remains crucial.
Finally, it is a matter of controversy whether retroperitoneal haematomas should be surgically evacuated
or conservatively treated and the final decision should be made after taking into consideration
patient’s general condition and the possibility of permanent femoral or sciatic neuropathy due to
compression syndrome

Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients’ admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality.